Mood and Affect Disorders

Michael H. Tang; Elizabeth G. Pinsky

doi:10.1542/pir.36-2-52

This article has corrections. Please see:

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Download PDF

Michael H. Tang, MD*
Elizabeth G. Pinsky, MD^†

^*Department of Psychiatry, Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital and McLean Hospital, Boston, MA.
^†Department of Psychiatry, Harvard Medical School, and Departments of Psychiatry and Pediatrics, Massachusetts General Hospital, Boston, MA.

AUTHOR DISCLOSURE
Drs Tang and Pinsky have disclosed no financial relationships relevant to this article. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.

Abstract

Depressive disorders are common in children and adolescents, with estimates for depressive episodes as high as 18.2% for girls and 7.7% for boys by age 17 years, and are a major cause of morbidity and even mortality. The primary care pediatrician should be able to (1) diagnose depressive disorders and use standardized instruments; (2) ask about suicide, self-harm, homicide, substance use, mania, and psychosis; (3) triage the severity of illness; (4) be aware of the differential diagnosis, including normal development, other depressive disorders, bipolar disorders, and comorbid disorders, such as anxiety and substance use; (5) refer to evidenced-based psychotherapies; (6) prescribe first-line medications; and (7) provide ongoing coordination in a medical home. Pediatric bipolar disorders and the new disruptive mood dysregulation disorder (DMDD) diagnoses are controversial but not uncommon, with prevalence estimates ranging from 0.8% to 4.3% in children at various ages. Although the pediatrician is not likely to be prescribing medications for children with bipolar disorder and DMDD diagnoses, all clinicians should be familiar with common neuroleptics and other mood stabilizers, including important potential adverse effects. Basic management of depressive and bipolar disorders is an important skill for primary care pediatricians.